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This Article Full Text Full Text (PDF) Financial Disclosures All Versions of this Article: clinchem.2006.084194v1 53/4/552    most recent Submit an electronic Letter to the Editor about this paper Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wu, A. H.B. Search for Related Content PubMed PubMed Citation Articles by Wu, A. H.B. Related Collections Evidence Based Laboratory Medicine and Test Utilization Proteomics and Protein Markers

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes

Minneapolis, MN

Christopher P. Cannon

Boston, MA

Gary Francis

Cleveland, OH

Robert L. Jesse

Richmond, VA

David A. Morrow

Boston, MA

L. Kristin Newby

Durham, NC

Jan Ravkilde, Alan B. Storrow

Nashville, TN

Wilson Tang

Cleveland, OH

Alan H.B. Wu

San Francisco, CA
¹ Brigham and Women’s Hospital, Harvard University, Boston, MA.
² Medical College of Virginia, Richmond, VA.
³ Duke University Medical Center, Durham, NC.
⁴ Aarhus University Hospital, Aarhus, Denmark.
⁵ Vanderbilt University, Nashville, TN.
⁶ University of California at San Francisco, San Francisco, CA.
⁷ University of Maryland School of Medicine, Baltimore, MD.

^aAddress correspondence to this author at: Director, Rapid Response Laboratories, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201. Fax 410-328-5880; e-mail rchristenson@umm.edu.

The first 300 words of the full text of this article appear below.

	Introduction

 

• I. OVERVIEW OF THE ACUTE CORONARY SYNDROME...............553
  A. Definition of Terms...............553
  B. Pathogenesis and Management of ACS...............553
  
• II. USE OF BIOCHEMICAL MARKERS IN THE INITIAL EVALUATION OF ACS...............554
  A. Diagnosis of Myocardial Infarction...............554
  Biochemical Markers of Myocardial Necrosis...............554
  Optimal Timing of Sample Acquisition...............556
  Criteria for Diagnosis of MI...............556
  Additional Considerations in the Use of Biomarkers for Diagnosis of MI...............557
  B. Early Risk Stratification...............557
  Biochemical Markers of Cardiac Injury...............558
  a. Pathophysiology...............558
  b. Relationship to Clinical Outcomes...............558
  c. Decision-Limits...............559
  d. Therapeutic Decision-Making...............559
  Natriuretic Peptides...............559
  a. Pathophysiology...............559
  b. Relationship to Clinical Outcomes...............559
  c. Decision-Limits...............561
  d. Therapeutic Decision-Making...............561
  Biochemical Markers of Inflammation...............562
  a. Pathophysiology...............562
  b. Relationship to Clinical Outcomes...............562
  c. Decision-Limits...............563
  d. Therapeutic Decision-Making...............564
  Biochemical Markers of Ischemia...............564
  Multimarker Approach...............565
  Other Novel Markers...............565
  
• III. USE OF BIOCHEMICAL MARKERS IN THE MANAGEMENT OF NSTEACS...............565
  A. Clinical Decision-Making...............565
  Biochemical Markers of Cardiac Injury...............565
  Other Biochemical Markers...............567
  B. Biochemical Marker Measurement After the Initial Diagnosis...............567
  
• IV. USE OF BIOCHEMICAL MARKERS IN THE MANAGEMENT OF STEMI...............567
  A. Noninvasive Assessment of Reperfusion...............567
  B. Biochemical Marker Measurement After the Diagnosis of Acute MI...............568
  
• V. REFERENCES...............568
  

	I. Overview of the Acute Coronary Syndrome

 
a. definition of terms
Acute coronary syndrome (ACS)¹ refers to a constellation of clinical symptoms caused by acute myocardial ischemia (1)(2). Owing to their higher risk for cardiac death or ischemic complications, patients with ACS must be identified among the estimated 8 million patients with nontraumatic chest symptoms presenting for emergency evaluation each year in the US (3). In practice, the terms suspected or possible ACS are often used by medical personnel early in the process of evaluation to describe patients for whom the symptom complex is consistent with ACS but the diagnosis has not yet been conclusively established (1).

Patients with ACS are subdivided into 2 major categories based on the 12-lead electrocardiogram (ECG) at presentation (Fig. 1 ): those . . . [Full Text of this Article]

b. pathogenesis and management

	II. Use of Biochemical Markers in the Initial Evaluation of ACS

 
a. diagnosis of myocardial infarction
1. biochemical markers of myocardial necrosis
2. optimal timing of sample acquisition
3. criteria for diagnosis of mi
4. additional considerations in the use of biomarkers for diagnosis of mi
b. early risk stratification recommendations for use of biochemical markers for risk stratification in acs
1. biochemical markers of cardiac injury
a. Pathophysiology
b. Relationship to clinical outcomes
c. Decision-limits
d. Therapeutic decision-making
2. natriuretic peptides
a. Pathophysiology
b. Relationship to clinical outcomes
c. Decision-limits
d. Therapeutic decision-making
3. biochemical markers of inflammation
a. Pathophysiology
b. Relationship to clinical outcomes
c. Decision-limits
d. Therapeutic decision-making
4. biochemical markers of ischemia
5. multimarker approach
6. other novel markers

	III. Use of Biochemical Markers in the Management of NSTEACS

 
a. clinical decision-making
1. biochemical markers of cardiac injury
Low-molecular-weight heparin
Glycoprotein iib/iiia receptor inhibition
Early invasive strategy
2. other biochemical markers
B. Biochemical Marker Measurement After the Initial Diagnosis

	IV. Use of Biochemical Markers in the Management of STEMI

 
a. noninvasive assessment of reperfusion
b. biochemical marker measurement after the diagnosis of acute mi

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